Provider Demographics
NPI:1447507363
Name:M RAHMAN, D.O., S.C.
Entity type:Organization
Organization Name:M RAHMAN, D.O., S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALEKA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-409-4292
Mailing Address - Street 1:5457 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1703
Mailing Address - Country:US
Mailing Address - Phone:773-409-4292
Mailing Address - Fax:773-409-4298
Practice Address - Street 1:5457 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1703
Practice Address - Country:US
Practice Address - Phone:773-409-4292
Practice Address - Fax:773-409-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128847207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty